Contro Elena, Larcher Laura, Lenzi Jacopo, Valeriani Marina, Farina Antonio, Jauniaux Eric
Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS Sant'Orsola-Malpighi, University of Bologna, 40138 Bologna, Italy.
Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Diagnostics (Basel). 2023 Feb 3;13(3):571. doi: 10.3390/diagnostics13030571.
Background-There are conflicting data in the international literature on the risks of abnormal fetal growth in fetuses presenting an isolated single umbilical artery (SUA), and the pathophysiology of this complication is poorly understood. Objective-To evaluate if changes in diameter of the remaining umbilical artery in fetuses presenting an isolated SUA are associated with different fetal growth patterns. Study design-This was a two-center prospective longitudinal observational study including 164 fetuses diagnosed with a SUA at the 20-22-week detailed ultrasound examination and 200 control fetuses with a three-vessel cord. In all cases, the diameters of the cord vessels were measured in a transverse view of the central portion of the umbilical cord, and the number of cord vessels was confirmed at delivery. Logistic regression and nonparametric receiver operating characteristic (ROC) analysis were carried out to evaluate the association of the umbilical artery diameter in a single artery with small for-gestational age (SGA) and with fetal growth restriction (FGR). The impact of artery dimension was adjusted for maternal BMI, parity, ethnicity, side of the remaining umbilical artery and umbilical resistance index (RI) in the regression model. Results-A significantly ( < 0.001) larger mean diameter was found for the remaining artery in fetuses with SUA compared with controls (3.0 ± 0.9 vs. 2.5 ± 0.6 mm). After controlling for BMI and parity, we found no difference in umbilical resistance and side of the remaining umbilical artery between the SUA and control groups. A remaining umbilical artery diameter of >3.1 mm was found to be associated with a lower risk of FGR, but this association failed to be statistical significant (OR = 0.60, 95% CI = 0.33-1.09, value = 0.089). We also found that the mean vein-to-artery area ratio was significantly ( < 0.001) increased in the SUA group as compared with the controls (2.4 ± 1.8 vs. 1.8 ± 0.9; mean difference = 0.6; Cohen's d = 0.46). Conclusion-In most fetuses with isolate SUA, the remaining artery diameter at 20-22 weeks is significantly larger than in controls. When there are no changes in the diameter and, in particular, if it remains <3.1 mm, the risk of abnormal fetal growth is higher, and measurements of the diameter of the remaining artery could be used to identify fetuses at risk of FGR later in pregnancy.
背景——国际文献中关于孤立性单脐动脉（SUA）胎儿出现胎儿生长异常风险的数据存在冲突，且对该并发症的病理生理学了解甚少。目的——评估孤立性SUA胎儿中剩余脐动脉直径的变化是否与不同的胎儿生长模式相关。研究设计——这是一项两中心前瞻性纵向观察性研究，纳入了164例在孕20 - 22周详细超声检查时诊断为SUA的胎儿以及200例有三条脐血管的对照胎儿。在所有病例中，在脐带动脉中央部分的横切面上测量脐血管直径，并在分娩时确认脐血管数量。进行逻辑回归和非参数接受者操作特征（ROC）分析，以评估单条动脉的脐动脉直径与小于胎龄儿（SGA）及胎儿生长受限（FGR）的相关性。在回归模型中，对动脉尺寸的影响进行了调整，纳入了孕妇体重指数（BMI）、产次、种族、剩余脐动脉的侧别以及脐动脉阻力指数（RI）。结果——与对照组相比，SUA胎儿的剩余动脉平均直径显著更大（<0.001）（3.0±0.9 vs. 2.5±0.6 mm）。在控制了BMI和产次后，我们发现SUA组与对照组在脐动脉阻力及剩余脐动脉侧别方面没有差异。发现剩余脐动脉直径>3.1 mm与FGR风险较低相关，但这种相关性未达到统计学显著水平（OR = 0.60，95%CI = 0.33 - 1.09，P值 = 0.089）。我们还发现，与对照组相比，SUA组的平均静脉与动脉面积比显著增加（<0.001）（2.4±1.8 vs. 1.8±0.9；平均差值 = 0.6；Cohen's d = 0.46）。结论——在大多数孤立性SUA胎儿中，孕20 - 22周时剩余动脉直径显著大于对照组。当直径没有变化，特别是如果直径仍<3.1 mm时，胎儿生长异常的风险更高，剩余动脉直径的测量可用于识别妊娠后期有FGR风险的胎儿。
